Does my patient have chronic Chagas disease? Development and temporal validation of a diagnostic risk score.

نویسندگان

  • Pedro Emmanuel Alvarenga Americano do Brasil
  • Sergio Salles Xavier
  • Marcelo Teixeira Holanda
  • Alejandro Marcel Hasslocher-Moreno
  • José Ueleres Braga
چکیده

INTRODUCTION With the globalization of Chagas disease, unexperienced health care providers may have difficulties in identifying which patients should be examined for this condition. This study aimed to develop and validate a diagnostic clinical prediction model for chronic Chagas disease. METHODS This diagnostic cohort study included consecutive volunteers suspected to have chronic Chagas disease. The clinical information was blindly compared to serological tests results, and a logistic regression model was fit and validated. RESULTS The development cohort included 602 patients, and the validation cohort included 138 patients. The Chagas disease prevalence was 19.9%. Sex, age, referral from blood bank, history of living in a rural area, recognizing the kissing bug, systemic hypertension, number of siblings with Chagas disease, number of relatives with a history of stroke, ECG with low voltage, anterosuperior divisional block, pathologic Q wave, right bundle branch block, and any kind of extrasystole were included in the final model. Calibration and discrimination in the development and validation cohorts (ROC AUC 0.904 and 0.912, respectively) were good. Sensitivity and specificity analyses showed that specificity reaches at least 95% above the predicted 43% risk, while sensitivity is at least 95% below the predicted 7% risk. Net benefit decision curves favor the model across all thresholds. CONCLUSIONS A nomogram and an online calculator (available at http://shiny.ipec.fiocruz.br:3838/pedrobrasil/chronic_chagas_disease_prediction/) were developed to aid in individual risk estimation.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Diagnostic and Therapeutic Problems of Geriatric Headache

There is no difference in clinical characteristics of headache between old individuals and younger’s. However, differential diagnosis of migrainous aura and transient ischemic attacks may be difficult in old people who frequently have vascular risk factors. Old people have less headache than the young’s. Chronic tension headache is the most common primary type of headache in the elderly. Chroni...

متن کامل

طراحی مدل ساده ریاضی برای پیشگویی تنگی شریان کلیه

Background: Renal artery stenosis (RAS) is a known cause of secondary hypertension and renal failure. The most patients with renal artery stenosis are asymptomatic. So, the exact prevalence of this disease is unknown. The gold standard of diagnosis of RAS is renal angiography that is an expensive somewhat hazardous procedure and may revealed nothing. The aim of this study was to develop a simpl...

متن کامل

Temporal Bone Osteomyelitis in a Child Closely Resembles Lateral Sinus Thrombosis: A Case Report

Introduction: Temporal bone osteomyelitis is more commonly seen in immunocompromised patients and is very rare in non-immunocompromised individuals. Mucormycosis is a fulminating fungal infection caused by Mucor which is a saprophytic fungus commonly seen in diabetic patients. Here we report a case of temporal bone osteomyelitis in a child with a traumatic history which was causing clinical fe...

متن کامل

Serological diagnosis of Chagas disease with purified and defined Trypanosoma cruzi antigens.

Chagas disease is caused by the protozoan parasite Trypanosoma cruzi, widespread in the American Continent. A recent report of the World Health Organization estimated that 16-18 million people are currently infected and that about 90 million individuals living in endemic areas are at risk of contracting T. cruzi infection. The high prevalence and continental extension of Chagas disease in Latin...

متن کامل

Predicting risk of COPD in primary care: development and validation of a clinical risk score

OBJECTIVES To develop and validate a clinical risk score to identify patients at risk of chronic obstructive pulmonary disease (COPD) using clinical factors routinely recorded in primary care. DESIGN Case-control study of patients containing one incident COPD case to two controls matched on age, sex and general practice. Candidate risk factors were included in a conditional logistic regressio...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Revista da Sociedade Brasileira de Medicina Tropical

دوره 49 3  شماره 

صفحات  -

تاریخ انتشار 2016